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03080029 CITY OF CUPERTINO eulLDwc Df...SION PERMIT CONTRACTOR TNr�0 2M TJ,C , BUILDING ADDRESS: THE BATH ROOM INC PERMIT N003080029 OWNER'S NAME: 1910 W EL CAMINO REAL PERMIT ISSUE DAM JOHNSON THOMAS E 08/07/2003 PHONE' (650) 968-7666 SANITARY NO. CONTROL NO, ARCHITECrIENGINEER' BUILDING PERMIT INTO BLDG ELECT PLUMB MECH 0 0 0 0 ioo LICENSED CONTRACTOR'S DECLARATION w 1 hercay.f,ria mal l am licensed under provisions of chapter 9(Commencing lob Description ?it`y' with Section 7IM)orDivision 3 of the Business and Proressinns Code,and my license is in full force and effect. L ip: License Lic.x_ (oC� /e/'l Z BATHROOM REMODEL A�.E� ot-� Dam�Cmanscon, ARshe the se DECLARATION JAN 0 6 2004 d i i understand nations shall he used as public records tyU �Qy Licensed Pmfcssiunal OWNER-BUILDER DECLARATION BUILDING i F I hereby.(Fri.that 1 oro exempt from thee Contractor's License Law I'or the p o following reason.(Section 7031.5,Business and Professions Code:Any city(it county e m� which requires a Permit to construct,aacq improve,di molich,Or repair any someone 8000 0!a` prior in its issuance,also requires the applicant for such permit to rile a signed statement < that he is licensed pumment10 the pmvisionsof tire Contractor,License Law(Charter 9 Sq.Ft. Floor Area Valuation 4FG (commencing with Section?")Of Division 3 of the B usinesa and Professions Code)or �•that he is exempt dome from and Ne basis for the alleged exemption.Any violation of 34250009 . 00 Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of ane APN Number Occupancy Type notmrnedomfivehundreddollarsl$500). P Y YP ❑1,a owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered far sale(Sec.70,14,Business - d Inspections and Professions Code:The Contracmr's License Law doe`not apply m an owner of 102 — PIERS P property who builds orimproves thereon,and who does such work himself or through his own coal provided that such improvements are not intended or offered Console,If. 103 - UFER however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving Nat he did not build or improve for purpose of 104 - REBAR sale'). 105 - ANCHOR BOLTS ❑1,as owner of the property,am exclusively contracting with licensed convectors to 10 6 - SEWER & WATER construct the project(Sec.]044,Business and Professions Code:)The Contractor's Li cense law does not apply to an owner of property who builds or improves themon,and, 202 - UNDERFLOOR PLUMBING Lwho kerne Law.taeu for such projects with acontranor(s)liunud pursuant to me Contractor's 203 - UNDERFLOOR MECHANICAL Licenm ❑I am exempt under See. .B&P C tar this reason 204 - UNDERFLOOR FRAME Owner Data 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 1 hereby alarm under penally of perjury one of the following declarations: 301 — ROUGH PLUMBING l have and will maintain a Cenifcateof Consent msewnsute forworker's Compen- 302 - TUB be OR SHOWER cion,as provided for by Section 3700 of the Labor code,for the perromtance of the 303 — ROUGH MECHANICAL Vk tar which this permit is Issued. 304 - ROUGH ELECTRICAL 1 have and will maintain Worker's Compensation Insurance,as required by Section W idle Labor Cotle,for On performance of the work forwhich this permit is issued. 305 - FRAME My Worker's Cnm ,e.(ion msumncc carrier ane Policy number am: 306 — HOLDOWNS Ca m: _! C-• _Policy No.: 113'LY � 307 - INSULATION ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (This section need not to compoudi ire Permit is fnrone hundred dollars(SIM) 309 - EXTERIOR LATH ' t"les'.) 310 - INTERIOR LATH I certify Nat in the�maca work ran which Chia permit Is ismed,I ansa nal 311 — SCRATCH COAT employany person to beeomcsubjecuo the Workers'CnmpcnsatioaLawsofCeliforn313 - ROOF NAIL AppliantNOTICETOA aking thisCcnificamofExcmplion,ynushnid 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation provisions of the Lahm Code,you must 0z forthwith comply with such provisions or this Permit shall bedeemed minded. 502 - FINAL PLUMBING ENERGY zoCONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL, ENERGY [-.0, 1 hereby aftion Oat Ocre is a construction lending agency for the informanceof 504 - FINAL BUILDING ENERGY c4> the work for which this permit is issued(Sec.3097,Civ.C.) Leader's Name 505 - FINAL ELECTRICAL tg1 Q � z Lenders Address 506 - GAS TEST U0 I certify that 1 have read this application and sum that me above information is 507 - FINAL PLUMBING Y. correct,l agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorise representatives of this city to enter upon the FINAL MECHAN CAL U above-mentioned property for inspection purposes. O9 FIN gy (We)agree to save,indemnify and keep harmless the City of Cupertino againn t-t N liabilities,judgmcnu,cosu and expenses which may in any way becrve against said City 5 A NG UxU.' Aconsequence of Degranting 5TAN05this AN�`WILL COMPLY WITH LL ON-POINT Issued by: WORKS Date SOURC E 1 N5. Re-roofs Signature fpli om/Convacmr Dat. Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will' .applicant or future building Occupant store or handle haxeduus material as defeat!by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safely coca, 0Yes �Nu 1ss31(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicantor future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit harardnus sacurrumina is dcnnc istrdby the Bay Area Air Quality Managcmcnl all new materials for inspection. ict? ❑Year No Ihavc real the h0,Smuosm55O5,smquimmcnuundcr Chapter 6.95ofdm Calif., nice Health&atl C c,Scracir hatit i. m res pd25534.1undersund atif the Milling docs not curly hav mucor,that it is my responsibility m m 'ly t c acupant of the rcyuirc n whi Lam I tactpdonoissuanccoraCcNf2 of 1pancg Signat C Applicant D [e owner ar aunt nixed ag n, �Datc All roof coverings to be Class "B" or better CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew • COPY # 3 Sec : Twp : Rng: Sub: Elk: Lot : APN . . . . . . . . . 34250009 . 00 DATE ISSUED. . . . . . . : 08/07/2003 RECEIPT # . . . . . . . . . : 22731 REFERENCE ID # . . . : 03080029 SITE ADDRESS . . . . . : 22994 STANDING OAK CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER JOHNSON THOMAS E ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2660 RECEIVED FROM . . . . : THE BATH ROOM, INC CONTRACTOR . . . . . . . . LIC # 22324 COMPANY . . . . . . . . : . : THE BATH ROOM INC ADDRESS . . . . . . . . . . : 1910 W EL CAMINO REAL CITY/STATE/ZIP . . . : MT VIEW, CA 94040 TELEPHONE . . . . . . . . : (650) 968-7666 EE ID ----UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------- ---- ---------- ---------- ---- ------ ---------- --- ------- BPERMFEE VALUATION 8, 000 . 00 137 . 00 0 . 00 137 . 00 0 . 00 BPFIXTURE UNITS 4 . 00 33 . 32 0 . 00 33 . 32 0 . 00 BPLANCHK PERMIT FEE 137 . 00 116 . 45 0 . 00 116 .45 0 . 00 BENERGY PERMIT FEE 137 . 00 41 . 10 0 . 00 41 . 10 0 . 00 BREMFIXT NO. FIXTURES 2 . 00 2 . 22 0 . 00 2 .22 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BREMRECEPT NO. OUTLETS 3 . 00 3 . 33 0 . 00 3 . 33 0 . 00 BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 405 .26 0 . 00 405 . 26 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 405 . 26 17488 TOTAL RECEIPT 405 . 26 • fi RY OF CUPERTINO CIT OF PERMIT APPLICATION FORM a / CUPEI�TINO N4 3�2 J v Date: O Building Address: -Z_2_,fC7t1 Owner's Name: Phone #: nn�I, r routs. �ws��J yoB-25`7-SgbS Contractor: License#: TNI= P3ATu kwevi, INc, (DDNgzZ Contact: Cupertino Business License#: P 1z. d Building Permit Info: Bldg Elect Plumb Mech ❑ Job Description: Residential 0 Commercial ❑ Sq.Ft. Floor Area: / 2 $/Sq.Ft.: Cost of Project: db 1(J J Occupancy Group: Type of Construction: ATH OD Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits , foot BUILDING BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING as 73 1 of 3 6 PITY OF CUPERTIN0 C17Y0 PERMIT APPLICATION FORM CUPEkTINO Quanti!y Fee ID Fee Description Fee Gro up BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE BIdg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING . BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain&Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREWIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 i CITY OF CUPERTIAO CITY-oF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch&Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL BREMSIGNS Remodel Sims,Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING. BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE PlumbingPermit Issuance PLUMBING PPLBG PlumbingFees foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 THE BATH ROOM, INC. JDB T++N40r4,IIo 4AU, 1910 West EI Camino Real Unit E SHEET NO. OF MOUNTAIN VIEW, CALIFORNIA 94040 (650) 968-7666 CALCULATED By DATE FAX (650) 968.2151 www.thebathroomine.eom CHECKED By DATE SCALE PLL W4 Zzgq�l s- ft ojVH OA k C�j Ni I NpovJ G/POO, 44CJ"757' �lb� tAE_BRT}i QW.- INC.. A; IZE6EsSC0 IZD /kPpROVED :IN ACCORDANCE WITH THE CITY OA. {:UPERTINO CODES AND ORDINANCE$ )ATE zy...r 31GNED P This set or i�scfll .+,F soacifmation$ MUST 91q TnLy ... ne kept nn the €o er all 'imes and it is on lawful to Mike any changes or alterations m'-same wiih,;c: w .ttenperFl}sslon from ' 1he lbu d ng uct: C ty of Cupe tino je pig �� vKlprov.lmof thef bola oo l;md sor to btlont t or br bc,� V. vicil of any provlszrP. . if Bav City Ordinance or itata S.arv; SwPEyF'yJorU<-. (>-g7LAc - 7v FWD CULT IrmA nlpTD'S Z. 12Epcfrfte VAL v l . SNowY2_VAIVE Is �/( sS F FSAIAI�C�t7 (A 'C.-C NT-NMIry . ;5 INsrt�u- Z,QEcci�c;i^ �nr/.LJ(ntJ7 _' lNsrnw� LL7D _. I. �� ,a I ljl11 CITY OF CUPERTINO �r.i BUILDING DIVISION PERMIT CONTRACTO INFORMATION ' BUILDING ADDRESS: THE BATH ROOM INC PERMITNO03080029 R'S NAME: 1910 W EL CAMINO REAL PERMIT ISSUE DATE JOHNSON THOMAS E 08/07/2003 NE (650) 968-7666 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: ERMINFO PLUMB MECH ioo LICENSED CONTRACTOR'S DECLARATION O O O t a 1 hereby afprm that lam licensed under pmshmra of Chapter 9(commencing lob Descript At4 ?z with Section 90(d))of Division 3 of Or Business and Professions Code.and my license is J�1r H in full force and effect. L �/7 Z BATHROOM REMODEL n= License Lie.9 — BUILDING t„o Dam Contrecmr BU'' . epp ARCHITECTS DECLARATION r f C a 1 understand my plans shad he used as public records )yU rw� Licensed Professional g OWNER-BUILDER DECLARATION aI I hereby affirm that I am exempt from the Contractor's License Low for the .00 following reason,(Section 703 1.5,Business and Professions Code:Any city or county <$� which requires a permit to construct,alter,improve,demolish,or repair any structure $8000 '_'ii prior to its issuance,also requires the applicant(orsuch"n itm Man sigacdamunnum e that he is licensed pursuant to the provisions nhheCormactursLicense Law(Chapter9 Sq. Ft. Floor Area Valuation •FC (commencing with Section 7000)of Division 3 nine Business and Professions Code)or �` to "xe 34250009 . 00 �$ Nat he is exempt memfrom end the basis for me alleged exemption.Any violation of Section 70313 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number, Occupancy nut mmc than five hundred dollars(SSW). Pane Y Type D 1,az owner of the property,or my employees with wages as their sole compensation, will do the work,and me swcium is not intended or offered for sale(Sec.'/0a4,Business' — and Professions Code:The Contractor's License Law does not apply to an owner of 102 — PIERS d Inspections property who builds or improves thereon,and who does such work himself or through his Own employees,provided that such improvements arc not intended or offered for sale.If, 103 — UFER however,the building or improvement is sold within one year of completion,the owner- builder will have Ne burden of proving Nat he did not build or improve for purpose of 104 — REBAR sa1c')' 105 — ANCHOR BOLTS D 1,as owner of the property,am exclusively convecting with licensed contractors to 10 6 — SEWER & WATER construct the project(Sec,7044,Business and Professions Code:)The Contractor's Li cense Law does not apply to an owner of property who builds or improves Osmon,and, 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s)licensed pursuant m the Contractor's License Law. 203 — UNDERFLOOR MECHANICAL D l am exempt under Sec. .B&P C for this reason 204 — UNDERFLOOR FRAME r Date 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby aR3mr under penalty of pxrJmy one of the following declarations: 301 — ROUGH PLUMBING I have and will maintain a Certificate of Consent sal f-insum for Worker's Com"n' 302 — TUB & OR SHOWER .Orion,as provided for by Section 37W of the Labor Code,for the Performance of the 3 03 — ROUGH MECHANICAL workerwhahthispermitisissued. 304 — ROUGH ELECTRICAL I have and will maintain Workers Compensation Insunmet,az m4uimd by Section 3 0 5 — FRAME Oq1 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Cnm n on lmuranec cart her anupolicy n—umsber a.rrer,,:,,��,�sa ��)�� 306 — HOLDOWNS Carrier. SOPndcyRO f�3—loe-5(456 307 — INSULATION ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 — SHEETROCK Trnjssectlnn need notbecompleud!Ulan permiasforoae hundnddodar.(Slro) 309 — EXTERIOR LATH efI"') 310 — INTERIOR LATH I earthy that in the peof,, 'qt c�f me work for which this permit is issued,1 shall not 311 — SCRATCH COAT employanypenonin any maArc/ m become subject m the Workers Compensation Laws of Cafimrn'✓lszm DDDJJJJssNHMMiY Applicant 313 — ROOF NAIL ��—s NOTICETOAPPLtICAbrnf,after making thisCeniOcamofExemption.youshould 501 — FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation provisions of the Labor Code,you must Jz forthwith comply with such provisions or this Penn irshall bedeemed revoked. 502 — FINAL PLUMBING ENERGY zCONSTRUCIONLENDING AGENCY 503 — FINAL MECHANICAL ENERGY E 1hereby aMn.that the reisaconstructinalending agency Iorthe forermanceof 504 — FINAL BUILDING ENERGY ee > the work for which this permit isissued(See.309),Cis.C.) Undcr's Name 505 — FINAL ELECTRICAL W Q az mer.Aadres. 506 — GAS TEST U O 1 certify that I have read this application and amm that the above information misting is 507 — FINAL PLUMBING Uw U H correct.l agree to comply with all city and county d state ccs and state laws relating to L OU building construction,and hereby authOTiMrepresentativesofthis city mcolor upon the FINA MECHAjNG CAL above-mentioned property for inspection purposes. Q 9 FIN (We)agree to save,indemnify and keep harmlus the City or Cupcnino against t: liabilities,judgments,costs and expenses which may in anyway scene against said City 5 ]-� U z in consequence of the granting of this permit APP LICA D STANDS ANO WILL COMPLY WITH LLi ON�POINT Issued by:5 WORKS Date Q SOURC E U 1 NS. Re-roofs Signature fphi im"Conumalor I VDahc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will' eapplicanr,or future building Occupant store or handle hararduus material az defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety ,dift,scea 2525532(.)7as *a All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haaardnus air coutdonants defined by the Bay Area Air Quality Management all new materials for inspection. istrict? ❑Yes No Acint / /,Ihavcaba ,Sectors255033sand534.1damtoselig + >/ Vmd niaHcalth&SafcryC c,Sccdom 255(15.25533 anJ 25574.1 undcrsmntl arifthc FuilJingdocs not- antly a tenant that it is my responsibility to o 'fy t e mcupmt ofmerequire wh hat t metp.orwissuanccoraCc_"Z of panty' Signa C D to Owner or auto rued ag m ' wm - All roof coverings to be Class "B" or better